SIGNATURE FORMS AND INSTRUCTIONS Due to the defaulted status of your loan(s), Direct Loans requires you to begin repayment in the Income Contingent Repayment program. REQUIRED FORMS Repayment Plan Selection Form Complete - Section 1: Fill in personal information. Section 4: Enter family size in Item 7. - If providing IRS 1040 Tax return as income documentation mark Yes in Item 8 then skip to Section 6. If you will not be providing IRS 1040 go to Section 5. Section 5: Item 10: If employed, Mark Yes and provide income documentation. Choose No if unemployed and/or have no taxable income and complete Self Certification form. (Be sure to include 30 days worth of pay stubs or most recent IRS 1040 tax return. If no acceptable form of income documentation is available (self employed, special situation), complete enclosed Self Certification of Income form.) (If you are unable to make payments once your consolidation is completed, contact Great Lakes Educational Loan Services, Inc. to request a deferment or forbearance of payment at 800-236-4300.) Promissory Note Also known as Form Section E and F; Promissory note Authorization Letter Sign, date and enter your social security number. Self Certification of Income Enter name, SSN# and family size. Choose the option that best describes your current situation and initial that option. If Other option is chosen please read instructions on form. If you have any questions or concerns regarding the forms, please call for assistance to complete the forms. Mail completed forms to: National Credit Management 10845 Olive Blvd #210 St. Louis, MO 63141 1-800-333-6787 This is an attempt to collect a debt. Any information obtained will be used for that purpose.
SELF CERTIFICATION OF INCOME/AGI For ICR repayment option Circle one I, the borrower/spouse (If required), SSN# hereby certify that my family size is. Family Size This number includes you and your spouse and is used to help determine your monthly payment amount for the ICR Plan. Family size includes your children if they receive more than half their support from you. This includes children who will be born during the year you certify your family size. At the time you certify your family size, these other individuals (1) live with you and (2) receive more than half of their support from you and will continue to receive this support for the year you certify your family size. Support includes money, gifts, loans, housing, food, clothes, car, medical and dental care, and payment of college costs. I have included a completed Additional Documentation of Income (ADOI) form and hereby certify my income situation as stated below. WARNING: Any person who knowingly makes a false statement or misrepresentation on this form shall be subject to penalties which may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097. Initial one of the following: (If choosing OTHER option below or if none of the below options apply, complete this form and include on a separate, clean sheet of paper, write a brief, but complete statement of your/spouses current income situation. Be sure to sign,date and write SSN on your statement. I am currently unemployed and have no taxable income. My source of income listed on the attached ADOI form, section 2: (Complete if no supporting documentation is available.) Company/Source of income name: Address of income source: OTHER You must list all taxable income you are currently receiving (i.e., income from employment, unemployment income, dividend income, interest income, tips, alimony). Include the amount of money received, how often you receive this money, and your employer (if any) or the source of your income if you are not employed. You must attach supporting documentation for all income reported in this section (e.g., pay stubs, letters from your employer stating your income, interest or bank statements, dividend statements, canceled checks, or, when these forms of documentation are unavailable, a signed statement explaining your income source(s) and giving the addresses of these sources). Copies are acceptable, but all supporting documentation must be no more than 90 days old. If you have more than two sources of income, provide the information requested in this section on a separate piece of paper and mail it with this form. Do not report untaxed income such as Supplemental Security Income, child support, or federal or state public assistance. If your income or the income of your spouse changes significantly after your submission of this form, you must notify the Direct Loan Servicing Center of this change Borrowers signature: Borrowers SSN#: (If required) Spouse signature: Spouses SSN#: Date signed: / / Date signed: / /